Provider Demographics
NPI:1073646741
Name:BRIDGES, TANJALESA (LCSW)
Entity Type:Individual
Prefix:
First Name:TANJALESA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TANJALESA
Other - Middle Name:COOK
Other - Last Name:ABEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:NC
Mailing Address - Zip Code:28789-0513
Mailing Address - Country:US
Mailing Address - Phone:828-508-8811
Mailing Address - Fax:
Practice Address - Street 1:1601 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4097
Practice Address - Country:US
Practice Address - Phone:828-337-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC146UAOtherBCBSNC
NC6106425Medicaid
NC6106425Medicaid